Breastfeeding,Non nutritive Sucking, Positioning Toolkit

Last modified by Lisa Stromquist on 2017/09/15 15:51

Welcome to the toolkit about breastfeeding, non-nutritive sucking and positioning that can be used to manage acute procedural pain for children. Current best evidence recommends these breastfeeding and non-nutritive sucking techniques for children ages 0 to 3 years of age.  Positioning can be used for  children of all ages.


Non-nutritive sucking, breastfeeding and positioning are physical pain management techniques that can be used in conjunction with (but not a replacement for) pharmacological and psychological pain management. Additionally, these techniques can be combined with oral sucrose and distraction. Links to recommendations and resources for these techniques can be found through the main webpage for the CAPHC acute procedural pain toolbox. 

The purpose of this toolbox is to make using the physical techniques of non-nutritive sucking, breastfeeding, and positioning techniques in clinical practice easier to use. The contents, which have been provided by your clinical colleagues from around the country, can help you move non-nutritive sucking, breastfeeding, and positioning use into your regular practice, support clinical education in these techniques and provide clinical and family resources to make these techniques easier to integrate into your practice. Use as many of the resources as you need and modify them to fit your organizational context. 


In this kit you’ll find:

  • Clinician and family resources to make non-nutritive sucking, breastfeeding positioning easier and more accessible to you and your patients
  • Clinical PowerPoint developed by your clinical colleagues to support education about using non-nutritive sucking, breastfeeding and positioning techniques for pain prevention and management. This slide deck can be modified and delivered for your needs and context  but please acknowledge the original authors and the CAPHC Pain CoP for their contributions.
  • Videos that can be shared with clinicians or families about the importance of non-nutritive sucking, breastfeeding and positioning for pain prevention
  • Background articles outlining the research evidence to support using non-nutritive sucking, breastfeeding and positioning for acute procedural pain

Please note, examples of policies are provided for reference purposes, only. We encourage all users of the toolkit who wish to adopt a similar policy at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created.

If you have any comments, questions or additions for the box, please contact CAPHC at

Thank you for supporting the CAPHC Pain Community of Practice’s mission to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability.

Family resourcesHandouts
Pain Free Injections in Babies

Let's Work together To Reduce Pain

Reducing Pain During Vaccinations - City of Ottawa Public Health Website

English Posters
Stay Calm and Cope On...

French Posters
Positionnement-bambin - CHU Ste Justine
Positionnement-enfant - CHU Ste Justine
Positionnement-nourrisson _ CHU Ste Justine
Positionnement-préscolaire - CHU Ste Justine
Clinician ResourcesPositions for Comfort Reference Chart  - CHEO
TREKK Bottom Line Recommendations: Procedural Pain (Translating Emergency Knowledge for Kids
Clinical PowerPointPain management during painful procedures - PowerPoint
Pain Management during painful procedures - PDF file
 VideosDeveloper: Dr. Denise Harrison
From: Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, University of Ottawa (English)
Baby Friendly Initiative endosed
Title and link: Be Sweet to Babies During Painful Procedures

itle and link: Breastfeed to Minimize Vaccination Pain 
Developer: Dr. Marsha Campbell-Yeo
From: Centre for Pediatric Pain Research IWK Health Centre and Dalhousie University (English)
Title: The Power of a Parent’s Touch in Reducing Baby’s Pain During Medical Procedures: It Doesn’t Have to Hurt
 Developer: CHU Sainte- Justine
From: CHU Sainte- Justine (French)
Title and video link: Piqûres sans blessure  - Video voie veineuse en pédiatrie 
 Developer: CHU Sainte- Justine
From: CHU Sainte- Justine (French)
Title and video link: Pour des soins en douceur - Capsules d’information et de prévention
Background ArticlesList of background articles PDF

Bueno, M., Yamada, J., Harrison, D., Kahn, S., Adams-Webber, T., Beyene, J., … Stevens, B. (2013). A systematic review and meta-analyses of non-sucrose sweet solutions for pain relief in neonates. Pain Research & Management, 18(3), 153–161.

Harrison, D., Bueno, M., & Reszel, J. (2015). Prevention and management of pain and stress in the neonate. Research and Reports in Neonatology, 5, 9–16. Retrieved from

Johnston, C., Campbell-Yeo, M., Fernandes, A., Inglis, D., Streiner, D., & Zee, R. (2014). Skin-to-skin care for procedural pain in neonates. Cochrane Database of Systematic Reviews, (Issue 1 Art. No.: CD008435. DOI: 10.1002/14651858.CD008435.pub2). doi:10.1002/14651858.CD008435.pub2

Pillai Riddell, R. R., Racine, N. M., Gennis, H. G., Turcotte, K., Uman, L. S., Horton, R. E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Lisi, D. M. (2015). Non-pharmacological management of infant and young child procedural pain (Review). The Cochrane Collaboration, 12, 1 - 197

Shah, P. S., Herbozo, C., Aliwalas, L. L., Shah, V. S. (2012). Breastfeeding or breast milk for procedural pain in neonates (Review). The Cochrane Collaboration, 12, 1 - 96

Stevens, B., Yamada, J., & Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews, (Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub4.).
Created by Lisa Stromquist on 2015/12/23 20:59